Neurosurgery Coding Alert

Question: Our surgeon did a suboccipital craniectomy and C1 laminectomy for resection of cervical medullary metastasis. How do we report this so that we also capture the C1 laminecetomy part of the procedure?

North Carolina Subscriber

Answer: This is a very unusual scenario which does not specify whether the location is intradural or extradural. If the primary location of the metastatic lesion was intraspinal, then options include 63275 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical), 63280 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical) or 63285 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical) depending on its location. You could append the 22 (Increased procedural service) modifier if the lesion slightly extended intracranially to prompt the suboccipital craniectomy.

Conversely, if the primary location was intracranial, you would report 61518 (Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull). Similarly, you may consider appending the -22 modifier if the tumor extended inferiorly enough to require a C1 laminectomy. The choice of a laminectomy or craniectomy code should be based on the primary location of the metastatic neoplasm.